Morning sickness during pregnancy: Should you be worried?

Dear doctor,

I am four months pregnant. I have been feeling normal all along, and I have not experienced morning sickness, or any pains. I had a scan done a few weeks ago and the baby looked fine. Is it okay to not have any symptoms or is something wrong with me?

Hellen

Dear Hellen,

Pregnancy causes significant changes, both physical and chemical. Because of this, the experience of pregnancy can have a variety of symptoms, in addition to the growing uterus. Every individual experiences pregnancy differently, and even with the same person, different pregnancies may be experienced differently.

Symptoms that may be experienced include nausea and/or vomiting, lack of appetite, metallic taste in the mouth, food cravings, breast swelling and tenderness, fatigue, backache, muscle cramps, headaches, passing urine frequently, mood changes, heartburn, constipation, itchy skin, changes in vaginal discharge, breathlessness, fluid retention, among others. Some symptoms may be present in early pregnancy, some later, some may be present throughout the pregnancy, while some symptoms may not be experienced during that pregnancy.

Morning sickness refers to nausea, vomiting and loss of appetite during pregnancy. The symptoms may be worse in the morning, but they can be experienced at any point during the day, or last the entire day (and night). It can begin at between week four and six of the pregnancy and lasts up to week 12 to 16. For some, morning sickness may continue for several months, or it may resolve then start again later in the pregnancy, and for others it may last through the entire pregnancy. It affects about two thirds of pregnant women, and there is a significant proportion of those who do not experience morning sickness. This in itself is not a cause for concern. As long as the pregnancy is progressing well and there are no danger signs, then do not worry about this.

Dear doctor, 

I think I have a problem. I am 28, and I do not have any close friendships or relationships. I don’t like to rely on people. I find it difficult to trust, and I get uncomfortable if we start getting close with someone. I always find a way to remove myself. I also don’t like people knowing details of my life. But I would still like to have a family sometime in the future. Can I be helped?

Harry

Dear Harry,

How we interact with others is based mostly by our early interactions (especially with caregivers or parents), our beliefs and our expectations. This forms a sort of template that we use over our lifetime when we relate with people, and it tends to remain stable over time, though different experiences can shape it. This template Is called an attachment style. It affects our psychological and social health and the kind of relationships that we have, whether positively or negatively.

In adulthood, the different attachment styles are: secure, anxious-pre-occupied, dismissive-avoidant and fearful-avoidant.

You may have the dismissive-avoidant attachment style. This means that you are very independent, you prefer to be in control, you are uncomfortable with being close to others, including family members, and you may use defensive techniques to avoid depending on others. In addition to being very private, you likely have a negative view of relationships and have difficulty asking for help. It is likely that others describe you as being cold and controlling.

The dismissive avoidant attachment style may develop as a result of child abuse or having to become self-reliant early in life because of neglected needs in childhood. Other possible contributing factors include genetics; brain changes; modeling from the parents’ attachment style; negative experiences in relationships and death of a loved one.

It is great that you are self-aware and that you would want to change for the better so as to accommodate a healthy long-term relationship. This is the first step in the journey to improving your attachment style. Take time to learn about the different attachment styles, and practise behaviours that improve how you relate to people. This also requires constant communication with those around you, and learning to manage any arising conflict. It would also be advisable to engage a mental health professional to address any underlying issues and provide support.

Dear doctor,

My dad is 70, and he recently got a fracture. We were told that his bones are weak. Is there a way to make them stronger other than taking bone soup?

Martin

Dear Martin,

Bone tissue is continuously undergoing breakdown and replacement. If the breaking down is happening faster than the replacement, then the bones become weak and brittle, a condition called osteoporosis. With osteoporosis, it becomes much easier to get a fracture, even from minor stresses.

Osteoporosis can affect anyone, though it is most common in post-menopausal women. Symptoms of osteoporosis may include becoming shorter over time, having a bending or stooped posture, back pain, and bones that break easily.

There is a higher risk of developing osteoporosis if you are older in age, if you are female, if you have a family history of osteoporosis, and if you have a small body frame. Hormone levels can also increase the risk of osteoporosis such as lowered estrogen in women, low testosterone levels in men, high levels of thyroid, parathyroid or adrenal hormones. Other risk factors include malnutrition, low calcium intake, long term use of some medications, some chronic illnesses, lack of exercise, tobacco use and excessive alcohol consumption.

The best way to maintain good bone health is by regular exercise and having a healthy balanced diet, rich in calcium and vitamin D. The easiest source of Vitamin D is exposure to the sun, though it is also found in some fish (trout and salmon), in fortified foods and in cod liver oil.

Diagnosis of bone density can be made using a special x-ray test. There are medications that can be prescribed to improve bone building and therefore strengthen the bone, in addition to calcium and vitamin D supplements and hormone replacement therapy, if necessary. Bone soup is a nutritious drink with health benefits, but it has not been proven to specifically strengthen bone.

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